GENDER PERSPECTIVE IN CARDIOVASCULAR PHARMACOLOGY & PREVENTION

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1 GENDER PERSPECTIVE IN CARDIOVASCULAR PHARMACOLOGY & PREVENTION Porter Avital, M.D Head of intermediate ICCU Dept. of Cardiology, Rabin Medical Center- Beilinson Campus, Petah Tiqva, Israel And the Tel Aviv University

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7 Stroke Incidence in Men and Women with Atrial Fibrillation Am J Cardiol 2004; 94: Marco Stramba-Badiale, Istituto Auxologico Italiano, Milan, Italy

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17 It is difficult for a woman 75 years of age, even with several markedly elevated risk factors, to exceed a 10% (let alone a 20%) 10-year predicted risk for CHD Thus, few women qualify for aggressive CVD prevention when 10-year risk is used to determine its need.

18 The AHA recently defined a new concept of ideal cardiovascular health defined by the absence of clinical CVD and the presence of : - levels of total cholesterol (.200 mg/dl), -blood pressure (.120/80 mm Hg), - fasting blood glucose (.100 mg/dl), -adherence to healthy behaviors, - lean body mass index (.25 kg/m) abstinence from smoking, participation in physical activity

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21 Because of its unique cardiovascular and metabolic stress, pregnancy provides a unique opportunity to estimate a woman s lifetime risk. Preeclampsia may be an early indicator of CVD risk women with a history of preeclampsia have approximately double the risk for subsequent ischemic heart disease, stroke, and venous thromboembolic events over the 5 to 15 years after pregnancy

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23 Appropriate referral postpartum by the obstetrician to a primary care physician or cardiologist should occur so that in the years after pregnancy, risk factors can be carefully monitored and controlled. Healthcare professionals should take a careful and detailed history of pregnancy complications with focused questions about a history of gestational diabetes mellitus, preeclampsia, preterm birth, or birth of an infant small for gestational age

24 Traditional risk factors - is there a gender difference?

25 HYPERTENSION In menopause there is impact of hormone differences on blood pressure and vascular properties Women appear more sensitive to target-organ injury and morbidity. The normal circadian blood pressure pattern may be altered after menopause For women who lack a normal nocturnal fall in blood pressure, echocardiographic studies indicate a twofold higher risk of developing left ventricular hypertrophy (LVH) at comparable

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33 Loop diuretics are useful for women who develop hyponatremia using thiazide agents; Beta-blockers are less effective in women but may be helpful in cases of tachycardia and over-activity of the sympathetic nervous system, atenolol should be avoided during childbearing years. Beta-blockers are likely to worsen glucose intolerance. ACE inhibitors are associated with a higher incidence of cough in women,

34 Diabetes Mellitus

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37 Risk of Fatal Coronary Heart Disease Associated with Diabetes in Men and Women BMJ 2006; 332:73 Marco Stramba-Badiale, Istituto Auxologico Italiano, Milan, Italy

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40 Worse impact on women Smoking

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42 PREVENTION

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46 ASPIRIN The AHA s Effectiveness-Based Guidelines for the Prevention of Cardiovascular Disease in Women 2011 Update specifies that aspirin mg/day is recommended in high-risk women with CHD and is reasonable in women with diabetes unless contraindicated; Aspirin 81 mg/day or 100 mg every other day can be considered in women aged 65 years, if blood pressure is controlled and benefits in terms of ischemic stroke and MI prevention are likely to outweigh the risk of GI bleeding and hemorrhagic stroke.

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54 EFFIENT

55 The gender differences in benefits associated with aspirin may reflect: -the later onset of CVD in women, -the greater proportion of ischemic strokes among women compared with men, -the relatively small incidence of MI among women and stroke among men, -gender differences in aspirin metabolism, -and the fact that aspirin resistance is more common in women than men.

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57 Hyperlipidemia is there a gender difference?

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59 6-Year CVD Death Rate Per Q 1 (<182) Correlation Between Serum Cholesterol and CVD Mortality Multiple Risk Factor Intervention Trial (MRFIT) N=325,346 Q 2 ( ) Q 3 ( ) Q 4 ( ) Serum Cholesterol Quintile (mg/dl) Untreated Patients Q 5 (>244) years years years years years. Kannel WB et al. Am Heart J. 1986;112:

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67 JUPITER AHA November 9, 2008

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70 In summary, for primary prevention, statin therapy reduces major CVD events in men and women. We can debate whether it reduces all-cause death, especially in women.

71 Despite evidence..gap!!!

72 Diet and activity

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76 Summary prevention

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95 End? This is Just the beginning.. Gender Equality

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